Initial United States clinical trial of robotically assisted endoscopic coronary artery bypass grafting

Damiano, Ralph J.; Ehrman, Walter J.; Ducko, Christopher T.; Tabaie, Harold A.; Stephenson, Edward R.; Kingsley, Charles P.; Chambers, Charles E.

doi:10.1016/s0022-5223(00)70220-0

Cited by 105 publications

(48 citation statements)

References 19 publications

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“…Robotic assistance clearly enhanced our surgical dexterity and allowed us to perform consistent endoscopic coronary anastomoses. 12 The robotic system addressed many of the physical limitations of traditional endoscopic surgery in the microsurgical setting. By allowing the surgeon's motions to be translated into a digital format, it was possible to remove all tremor by filtering all high-frequency motion.…”

Section: Discussionmentioning

confidence: 99%

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Prospective Clinical Trial of Robotically Assisted Endoscopic Coronary Grafting With 1-Year Follow-Up

Prasad¹,

Ducko²,

Stephenson³

et al. 2001

Annals of Surgery

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ObjectiveTo follow up in prospective fashion patients with coronary artery anastomoses completed endoscopically with robotic assistance. The robotic system was evaluated for safety and its effectiveness in completing microsurgical coronary anastomoses. Summary Background DataRecently there has been an interest in using robotics and computers to enhance the surgeon's ability to perform endoscopic cardiac surgery. This interest has stemmed from the rapid advancement of technology and the desire to make cardiac surgery less invasive. Using traditional endoscopic instruments, it has not been possible to perform coronary surgery. MethodsNineteen patients underwent robotically assisted endoscopic coronary artery bypass grafting of the left internal thoracic artery (LITA) to the left anterior descending artery (LAD). Two robotic instruments and one endoscopic camera were placed through three 5-mm ports. A robotic system was used to construct the LITA-LAD anastomosis. All other required grafts were completed by conventional techniques. ResultsSeventeen LITA-LAD grafts (89%) had adequate intraoperative flow. The mean LITA-LAD graft flow was 38.5 Ϯ 5 mL/ min. At 8 weeks, LITA-LAD grafts were assessed by angiography and showed 100% patency with thrombolysis in myocardial infarction (TIMI) I flow. At a mean follow-up of 17 Ϯ 4.2 months, all patients were NYHA class I and there were no adverse cardiac events. ConclusionsThe results from the first prospective clinical trial of robotically assisted endoscopic coronary bypass surgery in the United States showed favorable short-term outcomes with no adverse events. Robotic assistance is an enabling technology allowing the performance of endoscopic coronary anastomoses.During the past 10 years, surgeons have begun to explore strategies to decrease the invasiveness of cardiac surgery. Great strides have been made in the development of beating heart surgery, which eliminates cardiopulmonary bypass. 1 Techniques also have been developed to decrease the size of the incision, and some procedures can now be performed through small thoracotomies 2 and limited sternotomies. The next step in the evolution of minimally invasive cardiac surgery would be the development of a completely endoscopic procedure. The explosion of arthroscopic and laparoscopic techniques during the past several decades has revolutionized orthopedic and general surgery. However, endoscopic techniques have had little impact on microsurgical disciples, such as cardiac surgery. There are several reasons for this shortcoming. Traditional endoscopic instruments are not well suited for microsurgery 4 because of their length and the fulcrum effect. The length of the instruments magnifies even the smallest surgical tremor, making microsurgery difficult

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Section: Discussionmentioning

confidence: 99%

“…15 All of these features of the robotic microsurgical system combined to help enable the surgeon to perform endoscopic anastomoses. 12 The principal shortcoming of this study was that it did not represent a completely endoscopic approach. Most of the patients had a sternotomy to allow manual performance of the other bypass grafts.…”

Section: Discussionmentioning

confidence: 99%

Prospective Clinical Trial of Robotically Assisted Endoscopic Coronary Grafting With 1-Year Follow-Up

Prasad¹,

Ducko²,

Stephenson³

et al. 2001

Annals of Surgery

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“…It is evident that the results tend to improve as the team gains experience [26], in such a way that you can predict future results harmonious with the theoretical advantages and the initial enthusiasm. Some more sweeping clinical trials are already under way trying to confirm these expectations [27,29].…”

Section: Robotic Surgerymentioning

confidence: 98%

Emprego de sistemas robóticos na cirurgia cardiovascular

Sant’Anna

Prates

Sant'Anna

et al. 2004

Rev Bras Cir Cardiovasc

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The development of robotic systems for surgery started in the 1980s, motivated by the US army's requirement of surgical procedures in combat areas with the surgeon in a distant place (telepresence). But the first human application of robotic surgery occurred in a robotic surgery, years later.Cardiac surgeons were attracted by the robotic techniques due to the potential reduction in the invasive character of the procedures. This results in reduced trauma, fast recovery and low cost of surgery. Robotic systems were developed, allowing totally thoracoscopic cardiac surgery for myocardial revascularization and multi-site pacemaker implant in selected cases. Support systems for videothoracoscopic also exist and may give support to internal thoracic artery harvesting, mitral valve reconstruction correction of congenital heart defects. We have used the AESOP ® system, with HERMES ® voice control, to harvest the internal thoracic arteries, trans-thoracic implantation of left ventricular electrodes and to correct congenital heart defects.In spite of scientific enthusiasm relating to robotic surgery, there is no clear evidence of superiority of this technique if compared to conventional procedures in terms of results. The same is true with the cost of the procedures as even if a single robotic surgery is less expensive, the initial investment for a complete robotic system (console, video control, instruments) can only be compensated with many procedures. But there is no doubt that robotic surgery will have a place in the future of surgery, providing telepresence of the surgeon, allowing teaching and training and performing less invasive surgical procedures. Descriptors: Robotics. Cardiac surgical procedures, methods. Surgical procedures, minimally invasive. Resumo

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“…We evaluated the effect of pulmonary function testing on outcomes in TECAB in 174 consecutive TECAB patients at the University of Maryland; 16 of 174 (9.2%) patients required conversion to sternotomy. h, P=0.001), and longer hospital stay (6 [3-18] vs. 5 [3][4][5][6][7][8][9][10][11] days, P=0.001).…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

History and Current Status of Robotic Totally Endoscopic Coronary Artery Bypass

Lee

Srivastava

Bonatti³

2012

Circ J

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Robotic totally endoscopic coronary artery bypass (TECAB) is a minimally invasive endoscopic surgical approach using the daVinci robotic telemanipulation system to perform coronary artery bypass grafting on the arrested or beating heart. It is a procedure that can be a useful alternative to the classic open procedure performed through sternotomy. After extensive modeling in cadavers, the first clinical case was performed in June 1998 placing a left internal thoracic artery graft (LITA) to the left anterior descending artery completely robotically on the arrested heart. During the early and late 2000 s, international groups have adopted this evolving technology, which has included iterations such as beating-heart TECAB, use of bilateral ITA grafting and radial artery grafting, as well as 3- and 4-vessel TECAB. TECAB is combined with percutaneous coronary intervention in hybrid procedures. Despite increasing complexity of endoscopic coronary bypass surgery, conversion rates to open bypass surgery have dropped significantly and operative times have decreased. Published major morbidities and mortality rates in arrested- and beating-heart TECAB have been cumulatively in the 0-2% range and are considered well within the expected range for these highly complex surgical procedures. Long-term survival and freedom from major adverse events also meet the standards of open bypass surgery. (Circ J 2012; 76: 2058 - 2065

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Initial United States clinical trial of robotically assisted endoscopic coronary artery bypass grafting

Abstract: This pilot study demonstrates the feasibility of robotically assisted endoscopic coronary artery bypass grafting.

Cited by 105 publications

References 19 publications

Prospective Clinical Trial of Robotically Assisted Endoscopic Coronary Grafting With 1-Year Follow-Up

Prospective Clinical Trial of Robotically Assisted Endoscopic Coronary Grafting With 1-Year Follow-Up

Emprego de sistemas robóticos na cirurgia cardiovascular

History and Current Status of Robotic Totally Endoscopic Coronary Artery Bypass

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